Adult patients and parents who contacted the clinic early were not more likely to report being unsure that the symptoms represented a cold or being unsure how to treat the symptoms than those coming in after the first 2 days. There was also no greater likelihood that either adults or parents in the early calling group would report a history of any of the following: colds lasting longer; colds being complicated by sinusitis, otitis, or streptococcal infections; seeing a physician for a cold or being told by a physician to be seen; or receiving antibiotics for cold symptoms. Parents (but not adult patients) who made contact early, however, were significantly more likely to report a history of having recovered faster with an antibiotic prescription in the past (42% vs 22% and 23%, P=.01).
The only other differences among these 3 groups were in what they were seeking from the contact and whether they felt that the cold had lasted too long. Adult patients (but not parents) who sought care early were more likely to be worried about complications, while those who appeared later were more likely to want antibiotics and relief (Table 3).
Both adult patients and parents who made contact later were more likely to feel that the cold had lasted too long. For adult patients, 87% of groups that made contact later—but only 46% of those who made contact early—felt that the illness had been going on too long (P=.001). This finding was similar for parents of sick children but to a lesser degree (78% vs 58%, P=.01).
There were no differences in knowledge or beliefs about colds among these 3 groups for either adult patients or parents. Although more than 80% of all groups believed viruses cause colds, 50% believed bacteria also can cause them, and 80% agreed that getting tired and rundown causes colds. Eighty-five percent thought that colds resolve on their own, but 97% thought that rest helps, 66% felt that steam or Vitamin C helps, and nearly half believed in the value of chicken soup.
Finally, early callers were no more likely than those who came in later to report attitudes toward medical care or satisfaction with the visit that might affect their timing of medical care use. Thus, the duration of illness had no effect on respondent reactions to any of the following statements: (1) I will do just about anything to avoid going to the doctor; (2) when I am sick, I try not to let others know; (3) I usually go to the doctor as soon as I start to feel bad; (4) I have paid for my health insurance, so I might as well use it; (5) overall, I liked the manner in which my/my child’s problem was handled; (6) I trust the advice I was given for this illness; and (7) I would recommend this clinic to family or friends for an illness like this.
What about antibiotic use? Although 65% of patients received antibiotics within the 14-day observation period of our study, there was no relationship between receipt of antibiotics and the duration of symptoms at the time of first contact.
Discussion
Contrary to our original hypotheses and the expectations of many clinicians, symptomatic adults and parents of symptomatic children who seek medical assistance soon after the development of URI symptoms do not appear to be different in any important way from those making contact later. They do not have different demographic characteristics, beliefs about colds, or past experiences that might lead them to seek this very early contact. They are also not more likely to have different health status or to have different or more severe symptoms than those seeking care later in their illness (except for a somewhat greater frequency of fever). Although they are more likely to be concerned about complications, they are not any more likely to be unsure about the diagnosis or treatment and do not seem to want anything from the health care system that is different from those making contact later. Specifically, they are not any more likely to want antibiotics for their illness and are not more likely to receive them, despite the fact that parents who call or visit in the first 2 days are twice as likely to report that their child recovered more quickly with antibiotics in the past. Finally, they do not report attitudes toward medical care or satisfaction with the care of this illness that are any different from those who make later contact.
Because nearly one third of adult patients and two fifths of the parents of child patients seek care too early for the clinician to be very confident about the course of the illness, what is it that leads them to this action? There may be some reason that was not addressed in our survey, or the respondents may not feel comfortable admitting to their reasons in an interview sponsored by the health system. It seems more likely, however, that they are simply somewhat more eager to bring health problems to medical attention. The evidence-based guideline that led to our study suggests that almost all the patients in any of the groups we compared are seeking care too early.17